On Independence Day, President Donald Trump signed a massive 987-page budget bill into law—one that experts say marks a fundamental shift in federal spending priorities. The law upholds previous tax cuts, boosts funding for border security and fossil fuel industries, and slashes federal support for health care and climate protections.

“This represents the biggest rollback in federal support for health coverage ever,” said Larry Levitt, Executive Vice President for Health Policy at KFF. “It amounts to what is effectively a partial repeal of the ACA,” he explained, referencing the Affordable Care Act.

Levitt added that the bill includes a $900 billion cut to Medicaid—the largest in the program’s history—along with changes that “could lead to many people having their coverage canceled,” particularly through stricter eligibility rules and more frequent income verification.

One of the most controversial changes is the implementation of a work requirement for Medicaid expansion recipients. “4.8 million people are expected to lose health coverage, primarily because they fail to navigate the reporting process and the red tape that would be required,” Levitt noted.

The law also affects legally present immigrants who previously qualified for premium assistance. “Many low-income lawfully present immigrants would no longer be eligible for premium assistance under the Affordable Care Act. That would also be the case in Medicaid and Medicare,” Levitt said.

According to Natasha Sarin, professor at Yale Law School and Yale School of Management, the damage goes even deeper. “If you take what economists have done… the answer is over 100,000, and likely closer to 200,000” preventable deaths over the next decade due to loss of insurance coverage.

Sarin, who co-leads the Yale Budget Lab, said the federal deficit will rise by $3–$4 trillion, and the debt-to-GDP ratio is expected to balloon to 135% by 2035. “The bottom 40% of the distribution… is actually worse off after this bill than they were before,” she said. “The top 1%… are getting a huge tax cut.”

Environmental policy experts say the bill also poses a threat to global climate efforts.

“The big, beautiful bill is absolutely stuffed with provisions that are designed, quite clearly, to slow the transition to renewable energy,” said Bill McKibben, founder of climate action group Third Act. “The tax credit for electric vehicles expires as early as the end of September.”

McKibben warned of rising energy costs and more frequent disasters. “Families will be paying hundreds of dollars a year more in electric bills… and the estimate is that about one death in five on our planet comes from breathing the particulates and things that you get from fossil fuel combustion,” he said.

Cuts to federal emergency management, forest management, and environmental monitoring could compound those effects. “We’re literally turning off the satellites and pulling the plugs on some of the most important sensors and data,” McKibben said. “So that we won’t notice that the temperature is rising on our planet.”

Despite public backlash, many of the law’s most significant changes are designed to roll out slowly. “The changes are back-loaded, timed after the midterm elections… but the scale of the changes over the next decade is truly staggering,” Levitt warned.